Fixed drug eruption (FDE) is a distinctive type of cutaneous drug reaction that characteristically recurs in the same locations upon reexposure to the offending drug. Acute FDE usually presents with a single or a small number of dusky red or violaceous plaques that resolve leaving postinflammatory hyperpigmentation (picture 1A-C). Rare severe atypical variants of FDE, including multiple, nonpigmenting, and generalized bullous variants, share clinical features with Stevens-Johnson syndrome/toxic epidermal necrolysis.

Cutaneous skin reactions occur in approximately 2 to 3 percent of patients taking drugs. FDEs are less common than exanthematous (morbilliform) eruptions, which are estimated to account for up to 95 percent of cutaneous drug reactions [1-3]. FDEs occur in both sexes and in all age groups; in children, FDEs account for 14 to 22 percent of cutaneous drug reactions [4,5].

ETIOLOGY AND PATHOGENESIS

Eliciting drugs — Many drugs may induce FDE. The frequency with which individual drugs cause FDE varies over time and from country to country, depending upon drug availability and rates of consumption. Drugs most frequently associated with FDE include [6-8]:

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